A key tenet for giving advice or intervention at Bower Place is that change begins on the outside. By addressing the socio-relational world of a person seeking change, patterns of alliance and fracture are addressed to realign ownership with a view to the proper configuration of authority and willingness to take responsibility to solve a problem.
However, this does not mean that the inside neurobiological world of the person showing the symptom is ignored. For example, tailoring advice to a family seeking help to manage a violent child with an ADHD diagnosis would consider the child and possibly their parents’ capacity to attend, plan and organize. A better understanding of the inside can only enhance advice.
Adverse Childhood Experiences (ACEs) and Brain Function
It has long been recognized that childhood trauma physically changes the brain with alterations to brain volume, connectivity and blood flow. It is also clear that these experiences are linked to higher rates of adult psychiatric disorders. The question of how affected areas of the brain mediate this association was addressed by Keator (2024) who analyzed scans of 7,275 adults at rest and as they performed a task. These results were then analyzed in relation to various psychiatric diagnoses and identified which adverse childhood experiences were statistically related to each. The hypothesis was that ‘having ACEs as a child may alter one’s perception of the world, their experiences in it, and brain development/function. Such aberrant brain function, in adulthood, could be a potential mediator between ACEs and mental health diagnoses.’
What Did they Find?
Several critical regions of the brain showed alterations including the cognitive control network, the default mode network which is active when the brain is not engaged in a task and includes self-referential thought, mind-wandering, autobiographical memory, emotion regulation, future planning, and self-inspection, and areas of the dorsal striatum and cerebellum. These changes were associated with an increased likelihood of diagnoses including PTSD, anxiety disorders, substance use disorders, and depression.
What are the Behavioural Implications?
Altered brain activity patterns in these regions may present as difficulties in decision-making, emotional regulation, and cognitive control. Overactivity in the medial frontal lobe and anterior cingulate cortex may produce heightened emotional responses and difficulty in emotion regulation which are characteristic of PTSD and mood disorders. Decreased activity in the dorsal striatum, part of the brains basal ganglia may affect reward processing and motivation which present in substance use disorder and depression.
What Does this Mean for Clinicians?
Understanding that a client’s brain functioning is directly linked to the difficult experiences and behaviors with which they present, can help the practitioner think planfully about the advice they give and how it is delivered. Ensuring that advice is presented both verbally and in written or diagrammatic form ensures the client is more likely to understand, process and remember than if it is delivered only once in words. Establishment of patterns of obligation between client and practitioner which support the change process ameliorate the difficulty with internal motivation and are particularly effective with substance use disorders. The 1,000 days program developed by Malcolm Robinson at Bower Place harnesses this dynamic. By giving advice that directly addresses the client’s request in a way that helps manage emotional responses and gives opportunities to review and process information, a recursive loop between outside relationships which are perpetuating difficulties and inside brain function is established to create positive change.
Keator DB, Salgado F, Madigan C, Murray S, Norris S and Amen D (2024) Adverse childhood experiences, brain function, and psychiatric diagnoses in a large adult clinical cohort. Front. Psychiatry 15:1401745. doi: 10.3389/fpsyt.2024.1401745
©Copyright Bower Place Pty. Ltd. 2024
